2of4MONROVIA, LIBERIA - OCTOBER 09: A health worker takes the temperature of U.S. Marines arriving to take part in Operation United Assistance on October 9, 2014 near Monrovia, Liberia. Some 90 Marines landed on KC-130 transport planes and MV-22 Ospreys to support the American effort to contain the Ebola epidemic. The Ospreys, which can land vertically like helicopters, will transport U.S. troops and supplies as they build 17 Ebola treatment centers around Liberia. U.S. President Barack Obama has committed up to 4,000 troops in West Africa to combat the disease. (Photo by John Moore/Getty Images)Photo: Getty Images

3of4MONROVIA, LIBERIA - OCTOBER 09: U.S. Marines are briefed after arriving as part of Operation United Assistance on October 9, 2014 in Monrovia, Liberia. Some 90 Marines arrived with on KC-130 transport planes and MV-22 Ospreys to support the American effort to contain the Ebola epidemic. The four Ospreys, which can land vertically like helicopters, will transport U.S. troops and supplies as they build 17 Ebola treatment centers around Liberia. U.S. President Barack Obama has committed up to 4,000 troops in West Africa to combat the disease. (Photo by John Moore/Getty Images)Photo: Getty Images

4of44856 x 3264~~$~~MONROVIA, LIBERIA - OCTOBER 10: Sophia Doe (R), and her grand daughters weep as an Ebola burial team arrives to take away her daughter for cremation on October 10, 2014 in Monrovia, Liberia. The woman died outside her home earlier in the morning while trying to walk to a treatment center, according to her relatives. The burial of loved ones is important in Liberian culture, making the removal of infected bodies for cremation all the more traumatic for surviving family members. The World Health Organization says the Ebola epidemic has now killed more than 4,000 people in West Africa.The woman had died outside her home earlier in the morning while trying to walk to a treatment center, according to her relatives. The burial of loved ones is important in Liberian culture, making the removal of infected bodies for cremation all the more traumatic for surviving family members. (Photo by John Moore/Getty Images)Photo: Getty Images

DALLAS — Thomas Eric Duncan's temperature spiked to 103 degrees during the hours of his initial visit to an emergency room — a fever that was flagged with an exclamation point in the hospital's record-keeping system, his medical records show.

Despite telling a nurse he'd recently been in Africa and displaying other symptoms that could indicate Ebola, the Liberian man who would become the only person to die from the disease in the U.S. underwent a battery of tests and eventually was sent home.

Duncan's family provided his medical records — more than 1,400 pages in all. They chronicle his time in the ER, his urgent return to the hospital two days later and his steep decline as his organs began to fail.

In a statement issued Friday, Texas Health Presbyterian Hospital said it had made procedural changes and continues to “review and evaluate” the decisions surrounding Duncan's care.

Duncan carried the deadly virus with him from his home in Liberia, though he showed no symptoms when he left for the United States. He arrived in Dallas on Sept. 20 and fell ill several days later.

When he first showed up at the hospital, the man complained of abdominal pain, dizziness, a headache and decreased urination.

He reported severe pain — rating it an eight on a scale of 10. Doctors gave him CT scans to rule out appendicitis, stroke and numerous other serious ailments.

Ultimately, he was prescribed antibiotics and told to take Tylenol, then returned to the apartment where he was staying with a Dallas woman and three other people.

“I have given patient instructions regarding their diagnosis, expectations for the next couple of days, and specific return precautions,” an emergency room physician wrote. “The condition of the patient at this time is stable.”

After Duncan's condition worsened, someone in the apartment called 911, and paramedics took him back to the hospital Sept. 28. That's when he was admitted and swiftly put in isolation.

Duncan died Wednesday, almost two weeks after he first sought help. He was 45, according to the records. Relatives said he was 42. The discrepancy could not be immediately resolved.

Josephus Weeks, Duncan's nephew, said his uncle's care was “either incompetence or negligence.”

Either way “there is a problem, and we need to find the answer to it,” he said, adding that it was “conspicuous” that all the white Ebola patients in the U.S. survived “and the one black man died.”

The documents also show a nurse recorded early in Duncan's first hospital visit that he recently came to the U.S. from Africa, though he denied having been in contact with anyone sick.

The Centers for Disease Control and Prevention had alerted hospitals nationwide to take a travel history for patients with Ebolalike symptoms.

The hospital said it had made changes to its intake process and other practices “to better screen for all critical indicators” of Ebola.

Doctors who evaluated Duncan didn't respond to reporters' messages left at their offices.

A spokeswoman for the Texas Department of State Health Services said the agency was considering investigating the hospital for compliance with state health and safety laws.

The hospital repeatedly has changed its account of what the medical team knew when it released Duncan from the emergency room early Sept. 26.

A few days later, on Sept. 30, it initially said Duncan did not tell the staff he had been in Africa.

On Oct. 1, it said Duncan's nurse had been aware of the Africa connection but didn't share that information with the rest of the medical team.

The next day, the hospital blamed a flaw in its electronic health-records systems for not making Duncan's travel history directly accessible to his doctor.

A day later, on Oct. 3, the hospital issued a statement saying Duncan's travel history had been available to all hospital workers, including doctors, who treated him during his initial visit.

Dr. Amesh Adalja, an infectious-disease specialist at the University of Pittsburgh Medical Center who reviewed some of the records, said Duncan's travel history was listed in a nursing notice but not in the physician's note.

The patient's 103-degree fever might warrant “a little more investigation,” Adalja said. A chart showed he did not arrive with a fever but left with one.

By Duncan's second ER visit, the care was “impeccable,” the doctor said. Dallas physicians immediately signaled concern about Ebola and “spared no measure to try to keep him alive.”

After it became clear Duncan was suffering from Ebola, another option would have been to give him a transfusion from an Ebola survivor in the hopes that antibodies in the blood could help him fight the disease.

But Duncan did not receive a transfusion because the blood types did not match, the hospital said.

Dr. Kent Brantly, the first American flown back to the U.S. for treatment of Ebola, confirmed that account, saying he spoke with a doctor caring for Duncan and was willing to donate blood.

But their blood types were incompatible, he said Friday in an interview with Abilene Christian University's alumni magazine.

Also Friday, the World Health Organization announced that the Ebola death toll had surpassed 4,000 confirmed, probable or suspected Ebola deaths. All but nine were in Liberia, Sierra Leone or Guinea.